Surgical instrument



^ sept. 27, 1927. 1,643,631l

R. L. SCHULZ SURGICAL INSTRUMENT Filed Au. 27, 1925 u JNVENTOR. n @211011117212 Jdzulj.

M AUTTORNEYS. v

Patented Sept. 27, 1927.

UNITED STATES PATENT- oF'FicE.

RAYMOND L. SCHULZ, or Los ANGELES, CALI-roRN-ImAssIGNoR To-BoEnMfsURGrcA-L INSTRUMENTIGORPORATION, or.` lwcmzslrnn;v .NEW `Yom: vA' ACouponA'rrojN' oF NEW YORK.

'Application filed August' 27, 19123. Serial No. 659,453.-

The present invention relates to surgical instruments and more particularly to the type designed for permitting the operator to treatA various internalA cavities of the body, and anrobject of the inventionis to provide an instrument through which the flushing of a cavity such as the bladder may be eected underv the vision of the operator free from interference of air bubbles.` l

Tothese and other endsg'the invention consists of certainparts'and combinations of parts, all .of which: will be `hereinafter described :"the novel features-beingpointed out inthe appended claims. f

In the drawings:-'-V Y Fig.y 1 isa view of theinstrument in elevation; l

i Fig.v 2 is a section on the line 2F21, Fig. 1;

Fig. 3 is a fragmentary view inelevation at right angles thatillustratedin Fig. 1; vand Fig. fis a section on the linelf-e-ayFig. 1.

One o1 lthe difliculties in removing stones from the urinaryl bladder withfthe ordinary lithotrite kis that the process isf-not"l under suflicient visual control 'and it is not `easyjto get out all of the fragments even 'after'-l they have been crushed. Residual fragments bef come the nuclei fer furtherstone"l format-lon.

, have alimited lield for-use.'

Lithotrites which embody y a cysto'scopic telescope are now available.'V Some o-fthese instruments are of/soularge a calibre Yasto FCr -Crushllg stones, the Bigelow'li'thet'rite-VA is' still a very good! instrument' and joan be found in many hospitals. Most of the evacuatorsheretofere intusearermore orV less eumbersome. VThe work' has to be donerblin'dly'and'jconsiderable irrigationis` sometimes necessaryY Vinjorder to Vremove all fragments; Apparently no one method. is applicable toallj. cases. The' device hereV presented is intended to simplify the complete removal of all fragments of stone after litholapaxy.

In the illustrated embodiment of the `invention there is employed an electrically lighted cystoscope or other tube 1 of any suitable construction which is fitted upon a lateral extension 2 of the upright tube 3. In order to hold it to this connection the lateral extension 2 has a pair of ears 2a diametrically arranged and provided with in` wardly extending pins or projections 2b. The tube 1 has in opposite sides diametrically arranged bayonet slots 1 in which 'the pro- )ectlens or pins 2a. are adapted to enter in order to hold the cystoscope or tube 1 firmly to thefeztension 2. The lower end of the 'upright tube 3,5'is surrounded' by a stopper 4 of rubber or other yielding material tt-ed in a transparent bottle or container andopening. to said container.` Supported Vby the upright 3 in line with the cystoscopetube 1 is aview )p'enlyngl or window '6 inthe form of a lens; fitted'inthe end of a hollow plug 7 having a tight slip engagement Withia lateral VVextension 8 formed on theupright 3 oppositejtheY lateral extension 2 so that fthe use rof the' instrument may look directly into thefcystoscope, or tube 1 through the :upright "Chamber Or'tube 3.. f

Also connected to the upright chamber or tube 3 is yan evacuating 'bulb 9 whichthrough 'a'flexible tube 10 connects? witha curved lateral extension '11 secured tothe upright 3 below theview opening 6,2 awirelscreen 12 beingV positioned fat 'the inner end.; of' the tube 11 iu'sh with the 'inner wall of AVthe "chamber 3. At the'top of the upright cham- Vberor tube 3,1a domel 13 yis providedfpre'ferably in the formoff-a 'transparent dome shaped 'member' rigidly secured to` the upper en'd of theupright' member" 8 above'the `view opening and the cystoscopeY 'or`v tube Vconnection. Leading tl'iroiighfthe upperlend Vofthe chamber abovev the cystoscope '.connectionfis a vvent ltube 14. which extends Y'preferably 'uplward-ly into the'.A don`ie`13.l A,turning4 plug or valvel 15 is provided intheveiit ytub'eand fromY the ventftube a flexibleV tubefle may lea'dj'to :anyysuitab'le pointjrto conduct any water'passmg from .thefdeme at the time the latteris vented.' L

the instrumentare filled with water, the air being `allowed to' escape from the dome by means of the valve 15. During the filling with water, the bulb is gently compressed e L 'Ihe bladder stonesg' are crushed 'inthe i l usual* way withja lithotrite. The cystoscopic several times so as to expel all of the air. The instrument is then connected to t-he cystoscope tube, care being taken that the patients bladder is not over distended. The electric light is then turned on and one gets a clear view of the inside of the bladder through the observation window. Fragments of calculi are readily located. The suction bulb is gently and completely compressed while the other hand manipulates the cystoscope in search of fragments and brings the beak into proximity with them. Then the compression is slowly released, thus producing a` strong current of water which carries with it the fragments seen and deposits them in the bottle.y The entire process is visible throughout, the stones can be seen rushing up into the cystoscope and if a fragment does not pass readily, it may sometimes be coaXed up by'alternate compression and suction or manipulation of the beak of the cystoscope. If any air bubbles are present in the range of vision, these may be eliminated by opening the vent valve '15.

Such fragments as are too large to pass through the cystoscope must be either crushed still smaller or broken by means of a long snare which may be used in the same cystoscope through a special window. After the fragment' has been broken small enough, it may be evacuated immediately through the same tube.

Prior to'this invention a suction bulb or evacuating member with a bottle or container has been used in connection with va plain tube or cystoscope for evacuating' bodies from the urinary bladder, but this work has Anever been yunder visual control. IfV a direct view cystoscope were used it was merely for the purpose of inspection and a separate operation was required for the evacuation. In this invention, the evacuation takes place during the Ainspection and in addition it is possible to keep the field of vision free from air'bubbles.

By means `of vthis cystoscopic evacuator it is possible to clean out all fragments of stone more quickly and leave the bladder Vin a less traumatized condition than if stronger evacuators are used which are not under visual control. This method can be used without a general anaesthetic if the patients at one side thereof, a chamber for collectingV air bubbles, projecting from one side of the tube opposite the connection of the latter with the collecting receptacle, a bulb for creating a suction in the tube for -drawing the foreign matters into the collecting receptacle, and means for venting the air bubble collecting chamber.

2. A surgical instrument comprising a tube for insertion into a body cavity, means for permitting the inspection of the body cavity through the tube, a collecting receptacle having an air tight connection lwith one side of the tube, a transparent dome connecting with the tube to provide a chamber in which air bubbles may collect, means for venting such chamber, and a bulb for creating a suction in the tube. Y

8. A surgical instrument comprising an upright chamber, a tube connecting with said chamber for insertion into a body cavity, a viewing device in the chamber opposite said tube, a collection receptacle connected with said chamber below said tube for .drawing the foreign matters through the tube into the collection receptacle and an air' dome formed at the top of the chamber above the tube.

4. A surgical instrument comprising an` upright chamber, a tube connecting with said chamber for insertion into a body cavity, a viewing device in the chamber opposite said tube, a collection-receptacle connected with said chamber below said tube for drawing the foreign matters through the tube into the collection receptacle and an air dome formed at the top ofthe chamber above the tube, said air dome being provided with an air vent. Y

RAYMOND L. SCHULZ. 

